Provider Demographics
NPI:1194891549
Name:JAGADISH, LAXMI (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LAXMI
Middle Name:
Last Name:JAGADISH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2873
Mailing Address - Country:US
Mailing Address - Phone:732-651-3259
Mailing Address - Fax:
Practice Address - Street 1:44 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2356
Practice Address - Country:US
Practice Address - Phone:732-238-1664
Practice Address - Fax:732-613-9795
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS00263500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist